The View From Behind the Velvet Rope

Whether you’re covering a political campaign, a rock concert or the launch of a new cruise ship, one of the privileges of being a reporter is being allowed behind the velvet rope — to the front of the line, onto the stage or into the limo — to interview subjects. It’s not something I seek out (far from it), but as a business reporter who covered Wall Street and C.E.O.s for years, it came with the territory.

After being on the economics beat at The Times over the last five years, however, I’ve come to realize the real story in the American economy today is the velvet rope itself.

Sometimes, it’s a metaphor, as in the case of for-hire college counselors who can ease admission to Ivy League colleges. Or the butler-like Royal Genies on Royal Caribbean cruise ships who research your favorite scotch or vodka and have it ready before you board.

In other cases, the rope is literal: airport security, for instance, where first-class passengers speed through while everyone else snakes around in long queues. At many amusement parks, visitors can spend an extra $100 to cut the line and spare themselves the wait for the most popular rides.

Some theme-park experiences are even more rarefied. Located next door to SeaWorld in Orlando, and owned by the same company, Discovery Cove is quadruple the price, costing a family of four nearly $1,300 for a day. Here, attendance is capped, and instead of just watching the dolphins, visitors can actually swim with them.

When I donned a wet suit at Discovery Cove to learn what justified the price of admission and to let a dolphin gently tug me around a lagoon, I was delighted. It was a rare, special experience — and one that bore no resemblance to crowded but affordable amusement parks where Americans of all classes waited in line together, as I remember them from my childhood in the 1980s.

The proliferation of class-segregated, but side-by-side experiences — like Discovery Cove and SeaWorld, or the priority and regular lines at the airport — convinced me this was more than a single story. So I began writing a series on what I call the velvet rope economy.

My article today illustrates how the phenomenon has even extended to health care. A new breed of ultra-elite concierge doctors has sprung up in recent years, transforming medicine for the small sliver of patients wealthy enough to afford their care. Appointments with specialists that might otherwise take months to secure can be arranged in a day with a single call.

As concierge doctors gain clients, ordinary patients must wait more than three months to get an appointment with a typical family doctor in Boston, which is almost twice as long as it took in 2009. Even middle-class patients with private insurance must wait weeks or months to see a cardiologist or oncologist, while a wealthy few are immediately ushered into the waiting room at top research hospitals.

Unlike theme-park visits or air travel, health care can be a matter of life and death. And I was troubled by the growing practice of spending $40,000 a year for access to a concierge doctor, even if I could empathize as a parent with the desire to get the best care at any cost.

The one consolation, and perhaps the biggest surprise in my reporting, was that the doctors themselves, and more than a few of their patients, felt similarly uncomfortable about how class-bound our once-seemingly egalitarian society has become.

In a 2015 Times Op-Ed, a young physician drew attention to how hospitals provide particular blankets to benefactors and other V.I.P.s when they check in, quietly signaling those patients’ special status to doctors and nurses. Still, in the medical world and elsewhere, the conversation about this trend mostly takes place behind closed doors.

It’s a topic I want to keep exploring in additional articles, and eventually a book, and I’m eager to hear from readers how they view the topic and what kinds of barriers they encounter. Class in America is complicated, but it’s time we acknowledge that rising inequality is here to stay, with new velvet ropes rising up around us all the time.

A version of this article appears in print on , on Page A2 of the New York edition with the headline: The View From Behind the Velvet Rope. Order Reprints | Today’s Paper | Subscribe